Globally, asphyxia from apnea causes over 1 million neonatal deaths each year.1,2 Effective rescue breathing sustains life until the newborn's control of breathing improves. However, healthcare provider (HCP) anxiety, operator position, HCP training, crowded bed space and infant size are significant barriers to timely and effective delivery of rescue breathing. Additionally, training competency is transient, with a decline in newborn resuscitation skills reported within 12 weeks.15 Our long term objective is to improve the speed and ability of the primary HCP to assess and provide effective rescue breathing to newborns at risk for birth asphyxia by implementing an innovative bundled Infant Simulation Program for In-hospital Resuscitation Education - in the Delivery Room (INSPIRE-D) program, consisting of a Training Trigger, Team Huddle, Rolling Refresher training, Brief Team Reflection immediately after every resuscitation, and periodic Educational Debriefing intervention. The objective of this research proposal is to compare the effectiveness of the bundled INSPIRE-D intervention to standard American Academy of Pediatrics neonatal resuscitation training and education on HCP newborn resuscitation confidence and skill performance (competence). The overall hypothesis is that implementation of a novel INSPIRE-D bundle will improve HCP newborn resuscitation confidence and skill performance, and process of care associated with improved patient survival. Using innovative techniques, we will: 1) confirm incidence of resuscitative measures (rescue breathing), and baseline patient data characteristics, compliance with current guidelines, and patient outcomes prior to INSPIRE-D bundle implementation; 2) compare the effectiveness of a simulation INSPIRE-D intervention to standard neonatal resuscitation training on HCP rescue breathing competence and confidence; and, 3) compare the effectiveness of a simulation INSPIRE-D intervention to standard neonatal resuscitation training on important, measurable patient outcomes. The proposed research is significant, because it will optimize provider confidence, competence, and quality and safety of care for newborns with birth asphyxia. On successful completion, strong preliminary data suggests that this training intervention will yield high impact, durable skills and knowledge that can be disseminated to front-line clinical providers and will exert a sustained, powerful influence on thousands of newborns, healthcare providers, and the field of resuscitation science.